Provider Demographics
NPI:1376538314
Name:HORNER, TAMI S (MD)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:S
Last Name:HORNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9095 BELCHER RD N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4423
Mailing Address - Country:US
Mailing Address - Phone:727-548-0001
Mailing Address - Fax:
Practice Address - Street 1:9095 BELCHER RD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4423
Practice Address - Country:US
Practice Address - Phone:727-548-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87259207QS0010X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272511800Medicaid
FL272511800Medicaid
FLI17789Medicare UPIN